恶性血液病合并毛霉菌感染的临床特征及 预后分析

Analysis of Clinical Characteristics and Prognosis in Hematological Malignancies Complicated by Mucormycosis

摘要: 目的：探讨恶性血液病患者院内毛霉菌感染的临床特征及预后分析。方法：回顾性分析2021年6月至2025年3月青岛大学附属医院收治确诊为恶性血液病合并毛霉菌感染的26例患者的临床资料。根据疗效分为好转组(n = 14)和进展组(n = 12)，分析其临床特征、治疗及预后。结果：26例患者中，发热24例，咯血4例，胸痛2例，合并其他真菌或细菌感染患者20例(20/26)。原发病未缓解或复发状态、抗毛霉药物的延迟治疗及既往有真菌感染史的患者预后更差(P < 0.05)，抗毛霉药物的联合治疗与单药治疗相比无明显影响(P > 0.05)；Kaplan-Meier法及Log-rank检验单因素生存分析显示，抗毛霉药物治疗的启动时机表现出与患者生存率的显著相关性(P < 0.05)。结论：早期(≤5 d)启动以两性霉素B为基础的抢先治疗能改善患者生存率。本研究为小样本单中心研究，且高达76.9%的合并感染率可能对预后判断产生混杂干扰，相关结论仍需多中心大样本研究验证。

Abstract: Objective: To investigate the clinical characteristics and prognostic factors of hospital-acquired mucormycosis in patients with hematological malignancies. Methods: A retrospective analysis was conducted on 26 patients diagnosed with hematological malignancies and concurrent mucormycosis at The Affiliated Hospital of Qingdao University between June 2021 and March 2025. Based on treatment outcome, patients were divided into an improvement group (n = 14) and a progression group (n = 12). Their clinical features, treatment regimens, and prognosis were analyzed. Results: Among the 26 patients, fever was present in 24 cases, hemoptysis in 4, and chest pain in 2. Co-infections with other fungi or bacteria were identified in 20 patients. A poorer prognosis was significantly associated with the primary disease being in a non-remission or relapsed state, delayed initiation of anti-mucorales therapy, and a prior history of fungal infection (P < 0.05). However, no significant difference in outcome was observed between combination therapy and monotherapy with anti-mucorales agents (P > 0.05). Kaplan-Meier survival analysis with Log-rank test identified the timing of anti-mucorales treatment initiation as a critical factor affecting patient survival (P < 0.05). Conclusion: Early (≤5 days) amphotericin B-based therapy may improve survival. However, this single-center study had a small sample and a high co-infection rate (76.9%), which could confound the results. Thus, conclusions need validation in larger, multicenter trials.